title: Inductive foraging: improving the diagnostic yield of primary care consultations.
abstract: BACKGROUND
  Physicians attempting to make a diagnosis arrive at specific hypotheses early in their encounter with patients. Further data are collected in the light of these early hypotheses. While this hypothetico-deductive model has been accepted as both a description of physicians' data gathering and a norm, little attention has been paid to the preceding stage of the consultation.
  
  
  OBJECTIVE
  It is suggested that 'inductive foraging' is a relevant and appropriate mode of data acquisition for the first part of the patient encounter.
  
  
  METHODS
  Research evidence from cognitive psychology and medical reasoning research is discussed.
  
  
  RESULTS
  With inductive foraging, 'pattern failure' rather than 'pattern recognition' is the mode of discovery. Largely, guidance should be left to the patient to lead the clinician into areas where departures from normality are to be found. This is in contrast to active and focused 'deductive inquiry,' which should be used only after most aetiologies, but a few have eliminated.
  
  
  CONCLUSIONS
  Especially when the prevalence of serious disease is low, and a wide range of diagnoses must be evaluated, such as in General Practice, inductive foraging is a rational and efficient diagnostic strategy. Previously, too little attention has been paid to the initial stage of the consultation. Premature closure at this point may result in diagnostic error.
authors.affiliation: Department of General Practice, University of Marburg , Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Donner-Banzhoff
authors.forename: Ralph
authors.initials: R
authors.lastname: Hertwig
mesh_terms: D003657:Decision Making; D003951:Diagnostic Errors / Q000517:prevention & control; D058006:General Practice / Q000379:methods; D006801:Humans; D008962:Models, Theoretical; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods*